Skeletal Test-Out

If tracer concentration is visualized in the skeleton, kidneys and liver on a whole body bone image, the most likely explanation for these findings is that?

there is excess alumina in the generator elute

While performing a WB bone scan on a 62 yr old male, you notice focal areas of increased uptake on 4 adjacent ribs that appear to be in a linear arrangement. The most probable reason for the appearance of this scan is?

trauma to the chest wall

If tracer concentration is visualized in the skeleton, stomach, thyroid, and salivary glands on a bone image, the most likely explanation for these finding is that the?

radiopharmaceutical contained excess free Tc99m pertechnetate

When Tc99m HMPAO is used to label WBCs, which of the following reagents is omitted from its preparation?

methylene blue stabilizer

The administration technique for Tc99m ECD includes which of the following?

minimizing environmental stimuli

Which of the following image findings is the most consistent with choreography results of a Tc99m HDP sample demonstrating 85% radiochemical purity?

stomach and thyroid uptake

Before tracer administration, all of the following preparations are required for a 27 yr old women referred for total bone imaging except?

removing attenuating materials from the patient

Which of the following structures normally appear as areas of increased activity on the bone images of children?

costochondral junctions and epiphyseal plates

Static bone imagine is routinely performed how long after tracer administration to an adult?

2-3 hours

Which structures normally appear as areas of increased activity on the bone images of adults?

anterior iliac crests, glenoid fossa, sternoclavicular joints (also sacroiliac, hip, and acromioclavicular joints and vertebral column)

What condition is visualized on a bone image as a photopenic area?

attenuation

What is a photopenic area?

is one in which a smaller number of photons is visualized a "cold" spot

Referring to bone images, tracer concentration is increased in the area of what conditions?

acute myocardial infarction, osteomyelitis, and dose infiltration

Static bone imaging is performed several hours after tracer administration to permit?

blood clearance of excess tracer

Which clinical indication would limited bone imaging ("spot" views) be most appropriate?

evaluate temporomandibular joint pain

What is Paget's disease?

osteitis deformans (deterioration of bone tissue), associated with greatly abnormal radoopharmaceutical accumulation, typically involving the greater part of a bone.

Three or four phase bone imaging is particularly useful when what condition is suspected?

osteomyelitis

What are other names for Tc99m bicisate?

ECD and Neurolite

Maximum skeletal uptake of Tc99m medronate and Tc99m oxidronate occurs within?

45 minutes after tracer administration

What conditions result from child abuse?

Skeletal metastases, occult fractures, and Paget's disease

What is an occult fracture?

a hidden fracture, one that does not appear well on an X-ray

What is the first phase of a multiphase bone image called?

flow study

The first phase of a multiphase bone image, is important in demonstrating what?

increased blood flow to the affected area

What happens to the tracer concentration if a patient has osteomyelitis?

remains increased throughout the other phases

Which of the radiopharmaceutical's may be ordered to treat bone pain caused by bony metastases?

Sm-153 lexidronam

What is P-32 chromic phosphate used to treat?

pleural or peritoneal effusions

What is Sm-153 lexidronam used for treating?

bone pain

In performing a bone image, which view would best demonstrate an abnormality in the calcaneus?

plantar view of the feet

What is the calcaneus?

the heel of the foot

All of the following statements about four phase bone imaging are true, except?

the study may be performed with any blood pool agent

What are the 2nd-4th phases of a bone scan performed for?

to determine the presence of increased, persistent tracer uptake in the bone

When preparing to withdraw a unit dose of P-32 chromes phosphate, the technologist visually inspects the radiopharmaceutical and notes that it is a blue green color. The technologist should next?

withdraw the unit dose

What color is P-32 chromes phosphate?

blue-green color

For a patient undergoing bone imaging, all of the following information from the medical history is relevant to the interpretation of the bone image except?

- gallbladder surgery a year ago

- abdominal surgery 10 days ago

- radiation therapy to the breast 6 months ago

- results of previous bone imaging procedures

gallbladder surgery a year ago

Patient preparation for instilling colloidal P-32 chromic phosphate into the peritoneal cavity includes?

introducing Tc99m sulfur colloid into the cavity to confirm that the P-32 will disperse evenly

The administration technique for Tc99m bicisate includes?

minimize environmental stimuli

Which of the following components in a Tc99m medronate preparation is a radiochemical impurity?

Tc99m pertechnetate

If a patient has had external beam radiation therapy what may it cause in bone images?

photopenic areas, areas of decreased tracer activity on the bone image in the area where the therapy was delivered

If a patient who is having a bone scan urinates on the floor next to a camera, what would be the best course of action to reduce radiation exposure?

Remove the spill with some absorbent material and cover any residual activity with a lead plate or lead apron

Following administration of a bone imaging tracer, the patient is instructed to drink fluids to?

clear excess tracer from the blood

Which would not normally appear as an area of increased activity on the bone image of an adult?

epiphyseal plates

Which clinical indication would limited bone imaging ("spot views) be most appropriate?

rule out avascular necrosis of the right femoral head

Which phrase describes the sensitivity and specificity of bone imaging?

sensitive but not specific

What statement about three or four phase bone imaging are true, except?

no special instructions are given to the patient prior to the injection

What structures normally appear as areas of increased activity on the bone images of a child vs an adult?

costochondral junctions

Sr-89 and Sm-153 are used for what indications?

bone palliation therapy

It is best not to administer Sr-89 and Sm-153 directly via syringe because?

there is an increased possibility of local irradiation of soft tissue due to infiltration

What is a "spot" view image?

are individual images of certain areas after the initial whole body image has been performed

What is the delayed time for a four phase bone scan?

24 hours after injection

Which Rp for bone imaging has a faster blood clearance? MDP or HDP?

MDP

Which Rp for bone imaging has a greater bone uptake? MDP or HDP?

HDP

Approximately what % of the administered tracer is concentrated in bony tissue?

50%

Approximately what % of a bone dose is excreted from the body through the kidneys?

50%

What does osteoblastic mean?

bone formation

What does osteolytic mean?

bone destruction

For bone imaging, activity in the kidneys is usually less than or more than bone activity?

less

For which of the following clinical indications would limited bone imaging (spot views) with a pinhole collimator be most appropriate?

-Rule of skeletal metastases

-Evaluate Paget's disease

-Evaluate temporomandibular (TMJ) joint pain

-History of child abuse, rule out occult fractures

Evaluate temporomandibular (TMJ) joint pain

The images below demonstrate _________________.

(Image of flow, bp, and delayed foot with increased activity on all images of right big toe)

-Multiple myeloma to the tight great toe

-osteomyelitis in the right great toe

-Primary bone cancer in the right great toe

-metastatic bone disease in the right great toe

Osteomyelitis in the right great toe

Risk factors for avascular necrosis (AVN) of the hip include ___________________.

-Chronic steroid use

-osteoporosis and fat emboli

-All of the above

-fracture

All of the above

If tracer concentration is visualized in the skeleton, stomach, thyroid, and salivary glands on a bone image, the most likely explanation for the findings is the ____________________.

-Incorrect RPx was administered

-Patient was imaged too soon after tracer administered

-Patient renal function is compromised

-RPx contained excess free (tc99m) pertechnetate

RPx contained excess free (Tc99m) pertechnetate

Following administration of a bone imaging tracer, the patient is instructed to drink fluids to ________________________.

-Decrease radiation exposure to the bones

-clear excess tracer from the blood

-enhance visualization of the kidneys and bladder

-remove tracer from normal bone tissue

Clear excess tracer from the blood

________________ is the death of bone tissue due to lack of blood supply.

-multiple myeloma

-bone osteosarcoma

-avascular necrosis

-osteogenesis imperfecta

Avascular necrosis

Patients having a bone scan should be encouraged to void frequently between injection and delyaed scanning to ______________.

-Increase heterionic exchange

-decrease the risk of contamination during the scan

-aid the osseous phase of the scan

-reduce the radiation dose to the bladder

Reduce the radiation dose to the bladder

Intra-arterial injection of the bone radiopharmaceutical (Tc99m MDP) will _________________.

-Falsely increase the uptake of the tracer in the whole-body image

-cause gangrene

-go undetected

-Produce uptake in the arterial distribution

Produce uptake in the arterial distribution

A 49 year old female patient recieves 25 mCi of Tc99m MDP for a bone scan. The organ recieving the greatest radiation dose from the injection is the __________________.

-Kidneys

-Bladder

-bone marrow

-liver

Bladder

When performing a bone flow, the technologist should acquire _________________________.

-150,000 counts per image

-500,000 counts per image

-1 image per minute for 1 hour

-Sequential 1-3 second images for 60 seconds

Sequential 1-3 second images for 60 seconds

When using phosphate compounds for skeletal imaging, ___________________.

-Less than 30% of the dose localizes in the bone

-The critical organ is the liver

-These compounds localize in the same fashion as F-18 FDG as both use glucose metabolism

-The compounds localize via heterionic exchange into the hydroxyapatite matrix

These compounds localize via heterionic exchange into the hydroxyapatite mtrix

A bone scan of a 60 year old female demonstrates a diffuse pattern of intensely increased activity in the skull, entire left femur, and one side of the pelvis. This appearance is typical of what disease process?

-Nonossifying fibromas

-Legg-Perthe's Disease

-Multiple Myeloma

-Pagets Disease

Pagets Disease

Most bone fractures, in healthy adults, become positive on bone scans after _____________.

-12 days

-6 hours

-3 days

-1 hour

3 Days

The most appropriate study for a patient with increased PSA and elevated serum calcium levels would be a ____________________.

-Ga-67 whole-body scan

-In-111 WBC scan

-Triple-phase bone scan

-Whole body bone scan

Whole Body bone scan

An image positive for acute avascular necrosis (AVN) typically demonstrates a ______________________.

-Hot central defect surrounded by a cold ring

-Cold central defect surrounded by normal bony uptake

-Hot central defect surrounded by a less hot ring (double-density sign)

-cold central defect surrounded by increased activity

Cold central defect surrounded by increased activity

Static bone imaging is performed several hours after tracer administration to permit

-minimize tracer uptake in skeleton

-blood clearance of excess tracer

-tracer clearance from the kidneys

-tracer clearance from normal bone tissue

Blood clearance of excess tracer

Which of the following is an indication to perform a bone flow study?

-Differentiate osteomyelitis from cellulitus

-Metastatic prostate cancer

-screening for unknown cancers in the body

-cavernous hemangioma

Differentiate osteomyelitis from cellulitus

An obese man comes in for a bone scan. Your imaging table is rated for 400 lbs. The patient tells you he thinks he weighs about 180 kg. What should you do next?

-Have the patient initial the requisition confirming his weight

-Weigh the patient

-Perform the bone scan with the patient sitting in the chair

-Proceed with the study as normal

Weigh the patient

Bone cancers, bone metastases, and other bone disorders produce extremely high levels of __________ in the blood.

-Iron

-creatine kinase

-amylase

-alkaline phosphatase

Alkaline phosphatase

Typically, skeletal metastatic disease has the greatest involvement in (the) ______________________.

-Areas of synarthrosis

-Appendicular skeleton

-Areas of diarthrosis

-Axial skeleton

Axial Skeleton

Metastatic lesions that have no osteoblastic activity ________________________.

-Can be confused with a renal abnormality

-often result in breast uptake

-are usually detected as a photon-rich area

-are usually detected as a photon-deficient area

Are usually detected as a photon-deficient area

Which of the following is TRUE about multiple myeloma and bone scintigraphy?

-Multiple myeloma mainly affects the appendicular skeleton

-CT is the gold standard when imaging multiple myeloma

-bone scan images are poor due to no osteolytic activity

-bone scan images are poor due to no osteoblastic activity

Bone scan images are poor due to no osteoblastic activity